Allergists have been recommending baked egg (when tolerated) as an egg-allergy treatment for years. It’s a tried and true way to gently train the immune system to accept egg proteins. Egg OIT (Oral Immunotherapy) is an emerging technique to more rapidly introduce egg protein into the immune system. How do the two compare?
I smiled when I saw these study results from the American Academy of Allergy, Asthma, and Immunology (AAAAI). My son participated in this study from 2015-2017!
Baked Egg is a much easier therapy for families to incorporate into their lives, and it requires much less medical supervision. Egg OIT is newer, and is not widely available. According to the research site when we signed up, researchers wanted to know if one practice worked better than the other.
REMEMBER: I am not a doctor. Please don’t feed baked egg products to your egg-allergic child without consulting with your allergist. Likewise, do not attempt OIT on your own. Find a qualified allergist if you are interested!
My son Zax was among 92 children nationwide who helped researchers determine how Baked Egg and Egg OIT stack up. Some of them (52) were able to eat baked egg items without reactions. They were randomized into either the Baked Egg arm or the Egg OIT arm of the study. The rest (40) could not tolerate baked egg, and they were automatically placed in the OIT arm.
My son participated in the Baked Egg arm of the study. He ate a baked egg dose (equivalent to 1/3 of an egg) daily for two years. And let me tell you, that was a TON of baking!
The subjects in the OIT arm of the study received daily doses of egg white powder. The size of their doses increased every few weeks until they reached a maintenance dose, which they then continued to eat for the balance of two years.
Egg OIT Desensitizes Faster
Participants had to do two things to be considered desensitized for this study. First, they had to pass a food challenge and eat a cumulative 7,444mg of egg white powder. (An egg is roughly 6,000mg.) This was hidden in applesauce or pudding and eaten in increasing doses over a few hours. If they passed this challenge, they then challenged a scrambled egg.
Participants who ate Baked Egg daily for two years were desensitized to egg in only 22.2% of cases. Those who did Egg OIT were desensitized in 87% of cases.
My kiddo did not become fully desensitized. His threshold increased, but he didn’t get anywhere near tolerating a whole egg.
Does it last?
If (and only if) a subject was fully desensitized to egg, they were asked to stop daily dosing for two months and then come back for repeat food challenges. Sustained Unresponsiveness (SU) was achieved if they were still fully desensitized after the break from dosing.
Egg OIT participants also did better than Baked Egg participants in the SU department. 43.5% of desensitized Egg OIT participants maintained SU at their follow-up challenges. Only 11.1% of desensitized Baked Egg participants maintained SU. (Remember that there weren’t a lot of these to begin with.)
Remember, also, that even for those in OIT, that’s still less than half. Nearly every desensitization study of food allergies has proven the same thing here–you have to continue eating the food so you don’t lose your tolerance. Graduates of OIT are still allergic, and must still carry epinephrine, if indicated by their allergist, at all times.
Among those undergoing OIT, the children who could tolerate baked egg when they started maintained their SU at a much greater rate (43.5%) than those who could not tolerate baked egg at the beginning (17.9%).
Children who can eat baked egg are already partway towards being desensitized. Many allergists see it as a step in outgrowing the allergy. This may explain why those kids saw greater success.
The difficulty with any sort of immunotherapy is the risk of having adverse side effects, including an allergic reaction to the dose.
I was unable to see if participants in either group experienced anaphylaxis to their doses. I do know that OIT can result in anaphylactic reactions. OIT can also result in Eosinophilic esophagitis (EOE,) an allergic condition affecting the esophagus. I don’t know if those risks vary from food to food. The study did specify that the kids in the OIT arm had more reactions than those in Baked Egg. They also said that most symptoms were mild.
I do know that my son experienced a handful of mild reactions to his baked doses, and most of them were during the first year. Sometimes it was because I messed up a recipe and it wasn’t cooked enough. Once or twice it was because his doses were too close together (late dessert one night and early breakfast the next morning.) And during the first year, he had several reactions to his doses once pollen season started. For us personally, Zax’s reactions were always controlled with an antihistamine–and sometimes we didn’t treat at all, we just watched, and symptoms subsided on their own.
Accessibility of the Treatments
Remember that OIT (for any food) is not widely available. The FDA has not approved any standard procedure for OIT, so many (perhaps most) allergists don’t embrace it yet. A patient interested in OIT will have to search for a doctor who practices it, and may have to consider traveling for treatment.
On the other hand, eggs are available in every grocery store. It can be a little challenging to find recipes that fit the 30 minute baking-time criteria, but it’s relatively easy to incorporate baked egg products into a person’s diet.
Of course, patients that aren’t able to tolerate baked egg, and who are unable to find (or aren’t interested in) an OIT practitioner, have no option but to keep waiting.
What does the future hold?
Patient supporters of OIT think it should have been made widely available years ago. Some doctors are getting behind this idea as well, while others are still waiting.
The authors of this study, however, hope their data will help inform future treatments:
Ultimately, we hope this study helps identify optimal treatment options so patients can more quickly develop tolerance to all forms of egg.
First author Hugh A. Sampson, MD, Fellow of the AAAAI.
The benefits of egg oral immunotherapy are significant, and luckily the risk of adverse reactions are relatively low, especially for baked-egg tolerant patients. With further studies to validate our findings, I’m hopeful such treatment can be more widely implemented moving forward.”
Read my posts about participating in this study:
- Before screening: Potential Egg Allergy Study – and how I feel
- An early misstep: Don’t Lick the Dough!
- Summary 3/4 of the way through: An Egg Study
Read the press release here: https://www.aaaai.org/about-aaaai/newsroom/news-releases/egg-immunotherapy – AAAAI Press release
And the study publications here: https://www.jacionline.org/article/S0091-6749(18)32521-1/abstract